holy crap, Internet Oracle

[the_siobhan]

So it seems like if you want to get a lot of comments you ask a question about a controversial topic.

Let's experiment and see if I can do it again.

So I'm on a mailing list where the discussion topic is the ban on gay and bisexual men donating blood to Canadian Blood Services. The person defending this ban claims it is necessary to safeguard blood recipients against HIV and Hepatitis.

I claim overt bigotry.

What do you think?

[EDIT] To be precise, the actual ban is on men who have ever had sex with men. They also ask women if they have ever had sex with a man who has ever had sex with a man. They do not ask questions about safe-sex practices. They do ask if you have ever had a test for HIV and why.

Comments

[popecrunch.livejournal.com]

IF they can point at actual data and studies for this instead of simply saying 'numbers don't lie' AND the data and studies are based in fact (i. e. not falsified or 'shaped') THEN i will treat it as something other than 'don't want none of that damn dirty fag blood'. until then, it's bullshit and I suggest that people just plain lie about it.

[montieth.livejournal.com]

As someone whos grown up with dinner table conversation on subjects such as the HIV epidemic, I know they don't sit around offices making up numbers so they can pillory a segment of the population.(1) Yes there was funding back in the 80s that needed to be pushed towards the AIDs problem but the fact is that the transmission vector of unprotected sex is VERY risky where it comes to getting HIV/AIDS. The fluid borne pathogen is being deposited on an internal membrane (the anal wall) which is specifically evolved to absorb water and final bits of nutrients before passing out of the body. If there's a pathogen there, the money is on an infection from that. Its far lower if it's external or through other vectors. This is why you see certain diseases in Women more than men because women also have a similar nice warm incubator where an infection can develop and spread.

Combine that key transmission vector along with "riding bareback", and with many sexual partners over a short duration and you're going to see a higher incidence of sex in a given segment of the population (gay men) especially if that segment of the population is tighter knit and more prone to be using the same infected partners.

1. My step father and most of my parents friends were in those funding battles trying to get resources to attack the problem. My mother worked in a lab in Down Town Atlanta where they were trying to develop a test for infants who had HIV Antibodies (babies have the antibodies regardless of the lack or presence of an infection and the tests available at the time tested ONLY for antibodies).

[popecrunch.livejournal.com]

Sure but my point is if their research tells them that dudes who dick dudes have a risk of infection greater than that of heterosexuals by X percent then LET'S SEE THE DATA AND THE RESEARCH, ASSES. Because unless I've been missing something, all they've provided (and I have pinged ht ered cross several times on this issue) is 'We have research to back this up but we're not going to show you'. If they have the research to back it up, then ACES let's see it.

[montieth.livejournal.com]

It's not just the Red Cross and, in fact the American Red cross tried to get the limitations lessened to a degree. The US FDA demurred and said in absence of additional data to show the risks WERE lower, they'd not reduce that. Lets look at it this way:

Using 2005's infection rates with the 2000 population. (I don't have the time to look for 2000 incidence):

Total US demographics are 284,800,000 people by the 2000 census. Gay men account for about 2,000,000 of that, give or take.

In 2005 11,989 people of the US who were in the Non Male to male or injection drug use category were exposed and tested positive to for HIV.

5292 of those were men and women who engaged in IV drug use.
4255 of those were Adult and adolescent Males
7734 were adult and adolescent females.
263 people contracted HIV from other methods (perinatal, hemophilia, blood transfusion, etc)

Summed up that's 17544 all together. That's .0062%
Take out the IV drug users and it's 12,252 people in a given year or .0043%.

That same year 18296 men contracted HIV from MSM contact and another 1324 men both engaged in MSM contact AND used IV drugs. Thats 20,000 people out of a population of about 2,000,000.

~18,000 out of 2,000,000 is a percentage of .9% of that population, almost 1% of the population.

So for nearly 282,800,000 people, .0062% of that population will get HIV/AIDS.
For 2,000,000 people, nearly 1 percent of that population will get HIV/AIDS.

1: 2,000

Tell me again that homosexual men are NOT at high risk of contracting and having HIV/AIDS or of being carriers as compared to the rest of the population.

Here's my sources for pop figures:
http://www.adherents.com/adh_dem.html
and for infection/new case incidence figures:
http://www.cdc.gov/hiv/topics/surveillance/basic.htm#lwa

[popecrunch.livejournal.com]

Okay. Having ACTUAL DATA and ACTUAL SOURCES goes a long damn way toward easing my mind on this subject BUT. I'm still unhappy with the way it's being presented. I recognize that this is largely a semantic difference, and the data given shows a strong association between MSM contact and HIV transmission, but my statistics professor always hammered into me that correlation is not causation - it is at best socially awkward and at worst dangerous to assume that MSM contact is by itself and of itself high-risk behavior - when the real issue here is (mostly) unprotected sex, anal sex, or a combination of the two. Yes gay males do have an assload (laffo) more anal sex than their straight counterparts (for obvious reasons) and I will concede to the possibility of a greater chance of condoms not being used or not being used properly (specifically not due to an assumption that gay men don't care about disease transmission, but more that unwanted pregnancy isn't exactly a concern among MSM contact, so barriers may not be as high on the mental list as with hetero contact) but to paint all persons who report MSM contact ever at all forever in their entire lives as 'tainted'.. that's too much. MSM contact in the last six months (or year, to be REALLY sure) and I'd be happier, label it 'unsafe sex' in the last six months (or year) and I'd be happier still. The purely logic-based argument falls apart when you point out the gender difference: If John has sex with Mike in 1985, he's banned for life from donating blood. If Jane has sex with John also in 1985 but after he succumbs to his masculine urges with Mike, she's on the Dirty List for a year but is considered to be perfectly clean afterward (barring other factors like travel to Africa, IV drug use, or a habit of downing shots of infected blood at parties). If infection rates were higher in men than in women, I could understand this because the data would allow a conclusion to be drawn that men were more susceptible based (in whole or in part) on their gender - but the rates are higher in women, and by a significant margin (to use the data you provided above). Therefore, proclaiming a woman 'clean' of this particular risk after a year (or any other interval) of abstinence of sexual contact with MSM men while proclaiming an MSM man forever tainted makes no sense. Sure, you can use the 'people lie about sex' excuse, and yes they do, they do very much - but if you start skewing your questions based on the assumption that the answers you get are not going to be truthful, then you might as well scrap the whole thing since you can't trust ANY data.

So no, I'm not going to tell you that actively homosexual men are not at high risk of contracting or carrying HIV or AIDS as compared to the rest of the population - but I will tell you that the assumption that MSM contact (or contact with an MSM person) has varying periods for risk level based on gender is extremely suspect. If you are able to provide a reasoned explanation for that, then by all means, I would be really happy if I were wrong.

[montieth.livejournal.com]

I think there are a couple of factors here and I cannot speak with any authority on them but I'll try to see what I can explain or extrapolate:

1. There's probably a diminishing return on trying to find that untapped reserve of untainted blood in the MSM community from gay men who are no longer sexually active and are monogamous. The problem is finding those men and knowing when or when they are not a safe source for blood donations.

Further, immunology and public health policy works on averages and aggregates (I'd ask my mother about this as she was in grad school for public health but died of a heart attack in 2001 so my easy source for information on such things isn't around). But if I recall conversations about the subject with any clarity that's basically their targets. The Best bang for the buck as it were. Those averages, scientific estimates and collective groupings based on firm facts/numbers where you can get them and are just that. You look at a group, evaluate risks and make decisions on that risk.

Moreover, it's not a matter of being nice. It's not a matter of being fair. If I said that black men were likely to play basket ball, it'd be a not nice statement. If I said black men are more likely to have sickle cell anemia I'd be right and there's nothing nice or not nice about that statement. It's plain physiological fact that's clearly and firmly vetted in genetics. Clear facts about Tay-Sachs isn't anti-semitic, it's clear genetic commonalities among a given population. That community does what it can to clear up and screen for the genetic markers that would make that likely in a child.

People who make public health decisions look just at that fact and make decisions based on that. A disease isn't going to affect you more or less because you're offended. Using that as a basis for public policy is just plain dumb.

2. Woman on Woman contact sexually has a much lower incidence of transmitting HIV or AIDs than a lot of other methods of transmission. So that's a reason to discount that sector of the gay community. Physiologically the transmission vectors are different and that greatly affects the rates of infection. Can a lesbian get HIV from another lesbian, sure. But in my quick research on the subject it seemed like it was a very LOW incidence rate. Perhaps there are behavioral differences between Lesbians and Gay men that also affects their pattern of choosing sexual partners and thus lowers their rates of infections.

3. MSM contact is indicative of being gay. People advocating that their gender preference is not something that they can fix or cure are adamant about that. I tend to agree that it's a combination of genetics, in-vitro hormonal levels AND learned behavior which affects the final outcome with the in-vitro hormonal levels being the major factor. It seems outside of the realm of logic to argue that "a gay man can't be 'fixed or cured' and then argue that he's not ALWAYS going to be practicing risky behavior. Frankly my honest impression of gay men, and mind you this doesn't carry any ill will or intent, it's just an observation, is that they tend to be very promiscuous as a rule. Combine that with the HIV transmission vector and you've got a high risk group as a general rule. Trying to sort out the high and not high risk members of a small segment of the population that will have 1% of it's population contract HIV that year is pretty hard and probably a waste of resources.

[montieth.livejournal.com]

4. The problem with people lying is worse when you have a given percentage of a small population and a high incidence of infection who who have a given percentage who lie. We'll assume that lying among a given percentage of Gay men will be equal for the given percentage of people who don't practice MSM contact. Say 1 in 10 lie.

1 in 10 of the 1% of 2,000,000 is 2000 people who will be part of that risk group who has MSM contact but lie about it. 2000 out of a donor pool of 2,000,000 people seems pretty statistically significant.

1 in 10 of that .0043% of the 282,800,000 is 1200 or so people who are part of the larger general population. 1200 out of more than 280,000,000 people is not very statistically significant.

This might be the wrong methodology here, but we are just looking at those who are getting infected in that year (lag time before seroconversion has occurred but they're still infectious, their body just doesn't know it yet). Perhaps we should look at total infected population, but I do believe it's still heavily weighted towards a much greater percentage of the MSM segment of the population.

But you know, I think I just hit the nail on the head here. The key thing is that even WITH testing for antibodies which is the fastest way, if you expect EVERY test to be 100% effective for tests, you're still going to get some who are under the gun because their antigens haven't started being made but they have the HIV retrovirus in their blood. You can't test for antigens that aren't there. So you have to screen on behavior as well.

For your given population of donors, if 1% of a given population of 2 million is likely to have the virus but isn't going to test positive on the tests and .0043% of the much larger population of more than 280 million, then it's a pretty sure bet that you SHOULD exclude that 2 million as a donor source based on that behavior alone.

[popecrunch.livejournal.com]

Then again, screen on the actual behavior and not on sexual identity - unprotected sex and / or anal sex in the last N months where N is an interval where it is definite that antigens (or whatever indicator is tested for) are present (barring, of course, false negatives, which are not going to increase or decrease in rate based on sexual identity). Or at the very least, remove the distinction between males and females here (which you did not address in your replies). A woman who has sex with an MSM person does not have some magical ability to completely remove any risk after one year or any arbitrary period of time. If you ban MSM persons from donating blood for life, then it only makes sense to also ban women who have sexual contact with MSM persons. The only possible distinction is the assumption that a man who has sex with a man even once will continue to do so on a regular basis for the remainder of their life - which is simply not true. People experiment, get into drunken fumbles, lose bets at the family reunion - whatever the reason, sometimes men have sex with men and then stop having sex with men. To have MSM contact once does not make you gay, nor does having MSM contact once and deciding you don't like it (or deciding you don't like it after several times) 'cure' you. To pretend that no man can ever resist the siren song of manbutt once they give in to curiosity even once is a dangerously false notion.

[sushidog.livejournal.com]

I'm a little confused; you start by saying they should screen based on behaviour not identity (which is what they currently do; they don't ask whether people are gay, they ask whether they are men who have had sex with a man; that's behaviour, not identity) but you end by saying that they shouldn't judge on the behvaiour, but rather on identity.
Which is it?

[popecrunch.livejournal.com]

Many apologies, it was late and I was tired and distracted when writing. The behavior, definitely. But to assume that someone participating in MSM behavior once will continue to do so forever is unrealistic, was my point. People experiment and move on.